Disparities in Patient Portal Use

Patient portals are an increasingly prevalent way for patients to access their own health records and engage in their own care. As recently as 2018, data suggest that portals remain an underused technology(1). Furthermore, studies indicate that certain patient subgroups are significantly less likely to use patient portals(2,3).

Significance

Studies suggest that use of patient portals can increase medication accuracy and safety(3), improve quality outcomes(4), and increase patient and care partner activation in acute care(5) and outpatient settings(6). However, though 92% percentage of healthcare organizations reported offering portals in 2015(2), this technology has not been used by a majority of patients. Hong et al. analyzed data from the Health Information National Trends Survey (HINTS) and reported use rates of 25.6% in 2014,30.5% in 2017, and 31.4% in 2018 in the US.(1)

In addition, multiple studies have found that some patient subgroups are significantly less likely to use patient portals (2,3). These groups are also more likely to have adverse health outcomes and potentially stand to benefit from increased access to health information and engagement in health care. As Lyles et al. wrote in a commentary in the American Journal of Public Health in 2017, "From a clinical appropriateness and effectiveness perspective, arguably the most vulnerable populations have the most to gain from meaningfully interacting with their medical record data, through potential improvements in convenience, communication, and self-management."(3)

Groups Less Likely to Use Patient Portals

As reported by Grossman et al.in 2019 in the Journal of the American Medical Informatics Association (JAMIA), "More than 100 studies document disparities in patient portal use among vulnerable populations."(2) Groups for whom disparities have been reported include (with examples of publications demonstrating lower rates of use and/or barriers to use): older adults(7,8,9,10), individuals with lower socioeconomic status(10,11,12), racial and ethnic minorities(1,7,8,9,10), individuals with lower education level(9) and/or low health literacy(9,11), and individuals with disabilities(3).

Potential Interventions to Increase Use and Decrease Disparities

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Interventions at the patient-level and system level have been proposed to increase portal use and reduce disparities in use.

Hong et al. recommended "To reduce the digital gap in patient portal use, we call for structural interventions to provide broadband access in low-income communities, culturally appropriate programs topromote eHealth literacy, and evidenced-based policies to enhance public confidence in data safety."(1)

References

1 Hong YA, Jiang S, Liu PL. Use of Patient Portals of Electronic Health Records Remains Low From 2014 to 2018: Results From a National Survey and Policy Implications. Am J Health Promot. 2020 Jul;34(6):677-680. doi: 10.1177/0890117119900591. Epub 2020 Feb 7. PMID: 32030989.

2 Grossman LV, Masterson Creber RM, Benda NC, Wright D, Vawdrey DK, Ancker JS. Interventions to increase patient portal use in vulnerable populations: a systematic review. J Am Med Inform Assoc. 2019 Aug 1;26(8-9):855-870. doi: 10.1093/jamia/ocz023. PMID: 30958532; PMCID: PMC6696508.

3 Lyles CR, Fruchterman J, Youdelman M, Schillinger D. Legal, Practical, and Ethical Considerations for Making Online Patient Portals Accessible for All. Am J Public Health. 2017 Oct;107(10):1608-1611. doi: 10.2105/AJPH.2017.303933. Epub 2017 Aug 17. PMID: 28817324; PMCID: PMC5607665.

4 Heyworth L, Paquin AM, Clark J, Kamenker V, Stewart M, Martin T, Simon SR. Engaging patients in medication reconciliation via a patient portal following hospital discharge. J Am Med Inform Assoc. 2014 Feb;21(e1):e157-62. doi: 10.1136/amiajnl-2013-001995. Epub 2013 Sep 13. PMID: 24036155; PMCID: PMC3957401.

5 Schnock KO, Snyder JE, Fuller TE, Duckworth M, Grant M, Yoon C, Lipsitz S, Dalal AK, Bates DW, Dykes PC. Acute Care Patient Portal Intervention: Portal Use and Patient Activation. J Med Internet Res. 2019 Jul 18;21(7):e13336. doi: 10.2196/13336. PMID: 31322123; PMCID: PMC6670280.

6 Kruse CS, Bolton K, Freriks G. The effect of patient portals on quality outcomes and its implications to meaningful use: a systematic review. J Med Internet Res. 2015 Feb 10;17(2):e44. doi: 10.2196/jmir.3171. PMID: 25669240; PMCID: PMC4342639.

7 Goel MS, Brown TL, Williams A, Hasnain-Wynia R, Thompson JA, Baker DW. Disparities in enrollment and use of an electronic patient portal. J Gen Intern Med. 2011 Oct;26(10):1112-6. doi: 10.1007/s11606-011-1728-3. Epub 2011 May 3. PMID: 21538166; PMCID: PMC3181306.

8 Walker DM, Hefner JL, Fareed N, Huerta TR, McAlearney AS. Exploring the Digital Divide: Age and Race Disparities in Use of an Inpatient Portal. Telemed J E Health. 2020 May;26(5):603-613. doi: 10.1089/tmj.2019.0065. Epub 2019 Jul 9. PMID: 31313977; PMCID: PMC7476395.

9 Irizarry T, DeVito Dabbs A, Curran CR. Patient Portals and Patient Engagement: A State of the Science Review. J Med Internet Res. 2015 Jun 23;17(6):e148. doi: 10.2196/jmir.4255. PMID: 26104044; PMCID: PMC4526960.

10 Turner K, Clary A, Hong YR, Alishahi Tabriz A, Shea CM. Patient Portal Barriers and Group Differences: Cross-Sectional National Survey Study. J Med Internet Res. 2020 Sep 17;22(9):e18870. doi: 10.2196/18870. PMID: 32940620; PMCID: PMC7530687.

11 Ancker JS, Hafeez B, Kaushal R. Socioeconomic disparities in adoption of personal health records over time. Am J Manag Care. 2016 Aug;22(8):539-40. PMID: 27541700; PMCID: PMC5474311.

12 Latulippe K, Hamel C, Giroux D. Social Health Inequalities and eHealth: A Literature Review With Qualitative Synthesis of Theoretical and Empirical Studies. J Med Internet Res. 2017 Apr 27;19(4):e136. doi: 10.2196/jmir.6731. PMID: 28450271; PMCID: PMC5427250.

13 Sarkar U, Karter AJ, Liu JY, Adler NE, Nguyen R, Lopez A, Schillinger D. The literacy divide: health literacy and the use of an internet-based patient portal in an integrated health system-results from the diabetes study of northern California (DISTANCE). J Health Commun. 2010;15 Suppl 2(Suppl 2):183-96. doi: 10.1080/10810730.2010.499988. PMID: 20845203; PMCID: PMC3014858.

Submitted by Jennifer Lamberg, MD